title: The role of flooring as a design element affecting patient and healthcare worker safety.
abstract: OBJECTIVE
  The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare associated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care.
  
  
  BACKGROUND
  Most hospitals have not been explicitly designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care.
  
  
  METHODS
  A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design.
  
  
  RESULTS
  Of those 27 articles that met inclusion, 7 focused on healthcare associated infections; 9 focused on slips, trips and falls; 7 articles focused on noise; and 4 focused on fatigue. The studies are profiled in tables and organized by environmental variable.
  
  
  CONCLUSIONS
  Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided.
  
  
  BACKGROUND
  Evidence-based design, literature review, patients, safety, staff.
authors.affiliation: CORRESPONDING AUTHOR: Debra D. Harris, PhD, CEO, RAD Consultants, debra@rad-consultants.com; (512) 529-9355.
authors.forename: Debra D
authors.initials: DD
authors.lastname: Harris
authors.forename: Laura A
authors.initials: LA
authors.lastname: Detke
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D061214:Patient Safety; D017751:Safety Management